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Dual Medicare & Medicaid Eligibility

Medicare and Medicaid are national health care programs in the United States. Medicare is designed mainly for adults over the age of 65, while Medicaid is targeted at low-income individuals of any age, although most benefits go to children, people with disabilities and pregnant women. It is possible to qualify for both Medicare and Medicaid at the same time. These cases are called dual eligibles, and are generally classified as one of four different kinds.

  1. Qualified Disabled and Working Individuals

    • While Medicare was created mostly for senior citizens, persons under 65 can also enroll if they have certain health conditions, such as end-stage kidney failure. People who cannot otherwise receive Medicaid and lost their premium-free Part A Medicare benefits because they returned to work are called Qualified Disabled and Working Individuals (QDWI). If QDWI work but earn less than 200 percent of the federal poverty level, and have no resources exceeding two times the amount for Supplemental Security Income eligibility, they may become a limited form of dual eligible. The benefit of this kind of dual eligible is coverage of the Medicare Part A monthly premium but nothing for copays or deductibles.

    Specified Low-Income Medicare Beneficiaries

    • If you are entitled to Medicare and your income is 100 percent of the federal poverty level but less than 120 percent, you qualify for dual eligibility as a Specified Low-Income Medicare Beneficiary (SLMB). You also cannot have resources which exceed 200 percent of limit for SSI enrollment. SLMB dual eligibles get coverage for the Part B Medicare monthly premiums. You must re-apply for this every year and SLMBs are helped according to who applies first, as there is limited money for the program every year. After the allotted funds for the year run out, no more will be enrolled.

    Qualifying Individuals

    • If you are entitled to enroll in Medicare Part A and make 120 percent of the federal poverty level but less than 135 percent, you may be counted as a Qualifying Individual (QI). This program is also provided with a limited number of funds per year and operates on a first-come, first-served basis. If you get in, however, the program will cover your monthly premiums for Part B.

    Qualified Medicare Beneficiaries

    • Qualified Medicare Beneficiary dual eligibles get the most assistance. To be classified as a QMB, you must be entitled to enroll in Part A, have an income of no more than 100 percent of the federal level and no resources over twice the amount for SSI. The QMB program offers help covering the Parts A and B deductibles, the Part B premiums, the copays for Part B services and the coinsurance for skilled nursing facility care and extended hospital stays. If you qualify for full Medicaid, you can also get benefits for prescription drug costs. QMBs may also get assistance paying for Part A premiums if they cannot afford them.

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